Shouldn’t All Airlines Warn People about Lymphedema and flying?

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https://i0.wp.com/www.klosetraining.com/dynamicdata/data/images/treatment_BA_1.jpgThe first people who should warn women who have had any lymph nodes removed (for biopsies when they have breast cancer) about developing lymphedema are their doctors. Oncologists, nurse practitioners, radiologists and other doctors should be aware of the risks of their patients developing lymphedema in the arm or arms when any amount of lymph nodes are taken out of the armpit. Women with breast cancer who have radiation treatments also run the risk of having their lymph nodes damaged.

Lymphedema is a chronic type of swelling that isn’t fatal. But once a woman develops Stage II to Stage III and IV lymphedema, she can not be cured of the disease, only treated, and treatments require lifelong maintenance.

Once a woman who has breast cancer and had lymph nodes removed, she should be informed immediately about lymphedema risks, safety factors and prevention. Unfortunately, most specialists and doctors fail to even mention lymphedema to their patients with breast cancer. Most doctors know very little about lymphedema since the lymphatic system is one of the least studied systems in the body.

Now why should all airlines inform their patrons about lymphedema? Once in the air, the cabin pressure is low. People who run the risk of developing lymphedema may easily develop chronic swelling in their arms (or other limbs, depending on which lymph nodes or lymph vessels are affected) once in air. Most of my patients are women who develop lymphedema after they board airplanes without wearing compression sleeves and gloves/gauntlets. These women had had lymph nodes removed from their armpits for biopsies to rule out cancer in their nodes. They are breast cancer survivors.

As a rule of thumb, according to the National Lymphedema Network, anyone who has had any amount of lymph nodes removed, regardless of whether or not she has visible swelling, should wear compression garments when boarding a plane. Compression garments provide an external pressure that prevents lymph fluid from pooling in the skin, which leads to lymph swelling, otherwise known as lymphedema. For a woman who has had right armpit lymph nodes removed, she should wear a compression sleeve and a compression gauntlet or glove, pressure gradient of 20-30 mmhg. The garments should fit snugly but feel like second skin, so there shouldn’t be any bunching, wrinkles, or any tourniquet areas (too tight). For the legs, compression garments should have a starting pressure of 30-40 mmhg.

If a doctor can prescribe the compression garments, most surgical supply stores can fill the order and charge a patient’s insurance. With our health advances, it’s a shame so many women have to live with chronic lymphedema after they have combated breast cancer. I believe it’s not just the responsibility of health professionals to warn their patients about lymphedema prevention and safety factors. All airlines should do the same, because a majority of the cases of women developing lymphedema in the United States occurs after breast cancer survivors board airplanes without wearing the appropriate compression garments.

I am also surprised planes don’t warn people about DVTs (deep vein thrombosis) and risk reduction by just wearing compression stockings. I wonder if airlines are liable, should patrons die from developing DVTs and subsequently PEs, pulmonary embolisms, from prolonged plane rides. Or if women develop chronic lymphedema from the low cabin pressure. Hopefully, more health professionals and women become aware of lymphedema risks and prevention.

Kat Lieu, Doctor of Physical Therapy, Certified Lymphedema Therapist.

One thought on “Shouldn’t All Airlines Warn People about Lymphedema and flying?

  1. Asymptomatic thromboembolic events (big stinking clots that cause no symptoms) are often the nightmare of every practicing physician. These events often go undetected simply because these clots are lodged within the venous circulation, the system which is responsible for returning blood back to the lungs for oxygenation. Clots that are lodged in the arterial circulation, the system responsible for bringing blood to body tissues (e.g., you’re brain), are very often symptomatic. This is because the brain often needs blood to, um, think, I think.

    But the venous blood clot should never be overlooked, as the clot may travel with the blood supply returning to the lungs. Significant clot burden within the lungs can be an extremely dangerous event. The lack of symptoms and clinical signs make it even moreso. Also known as a pulmonary embolus, it can cause decreased oxygenation, marked heart strain, and death (e.g. David Bloom; NBC journalist died due to a pulmonary embolus). However, Dr. Lieu, it is not to my surprise that the airline industry has done little to address this. Simply because the data continues to be conflicting, and without strong evidence the industry lacks the courage to make a statement. Wimps. I am in strong agreement with Dr. Lieu regarding warnings to all individuals. Particularly vulnerable people with medical problems are at increased risk for clot development. Those same studies that gave the conflicting evidence; DID show in a subset analysis of people with “higher risk features” at least a 4-fold increase in events (Philbrick et al 2007). Since my last orbitz reservation, there was no box that I clicked “got clots? (or risk factors?)” Consulting your physician may be prudent before air travel as underlying medical conditions may need to be addressed.

    I would like to thank Dr. Lieu for also bringing to my attention the disease process known as lymphedema. Thank you Dr. Lieu. I have come to realize it’s a serious condition that is often overlooked, and I was not aware of its associated complications. Namely infection, physical disfigurement, and cases of lymphangiosarcoma.

    Although not an oncologist, I would presume infection is the most common as a significant number of those with compromised lymph nodes are cancer patients undergoing chemotherapy and radiation, and thus have their immune system compromised. I was not aware that the majority of lymphedema cases occurred in people who had recently been on planes. Telling these higher risk individuals certainly does not seem labor-intensive. It can help these individuals, as well as the airlines avoid future headaches. I know that I will now tell appropriate people about this risk.

    It would make sense for airlines to inform their passengers of the potential health risks for flying. They can then prepare for travel accordingly and consult their respective health care professionals for suggestions, e.g. Dr. Lieu. A simple questionnaire involved in the purchasing of tickets would be ideal and easy. Thank you again Dr. Lieu.

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